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} CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� Slate Fwm 5473 (R6/1-03)
Prescu6ed by the Department of Local GovemmeM Finance
INSTRUCTIONS: See �evcrse sidc Ior lilinq inslmclions
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� y FORM 1'EAR
y��' � � H�,o � �J
NOV 0� 2�04
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I (We) ,cer�fyithat�on.�he�lst�day�of�March, 20_
I(We) occupi d our prinapal place of residence the (ollowing described real pr erty (or which a Homestead Property T�c Credit is hereby daimed:
❑ I(We) ed ❑ Are buying under contract
Have enefidal interes� in the enlity Mat is liable for ihe property taxes on Ihe property and that owns ihe property or is buying under a conVact.
ciz�a'���-�..�T�,��i"���C�i=s.�'�����.F:�CONTRACT.'RECORUED.''.�`ac�'.`r;3y.�-�';�4'�`.s�a'�*'.��.,'.�'`8���.,�,�'�.�L.�Y�"-"�+ ,.'`�_',
I( buy'ug om m�Vad, Fee Simple owners name
Reardels ofice where wntraq is recorded Record number Page
County
m o(
Tamship
b61-CTIJ � e on
+dential sWCNre or the land nd ezceed' ane (1) aae Nat
b Produte iMOme. / �.
Is Ne pm
t �undsthat
�
townshiP)
ai property ❑ Mobile Homo (/.G. bf.1-�
is used b produce income. desaibe Ihe use and portbn
f�;�t�.A ES50'�R��S�E•� Y�i�` ��,�`�TRUEFTA7(� ASSESSED VALUE �HOMESTEAD��*` . NON=RESIDENTIAL "�-"��
�wp����A*.Ky, �-gf�.�y�-ya��,ti�,4y�k���y'-�,.F°.�,C� �a�VALU y� �`AT�700%O �T7Y� �VAL'UE�� ����y��VALUEf�jzp�."��=�E
Land not exceeding 7(one) aae immediatety ='���in'�"'`"'�.T°""�''° T"�` '�ts�
surrounding residentlal improvemenis. (� ) ��' � �-st �`En� � �
,�°�'� �''�di.-`�:�
Otfier land (Z� Y- � �. �r�^
����
Tdal land (Gne 1 plus line 2) (3�
�'Y-�.�-x••-. r �"3
Dwelling (4) ir���� „- ..f���:
Rasidential improvements a MnuaOy �"�"' '°`�"�" � t-'fi
Assessed MobOe I Manufac�red Hama - ''�:� a- ,--•`.;'�'}:�
Garage (5� H ��
° �...�f:�k�. ' oc `�'
.<��� x'�M{Y
Otherimprovements (6) r-- `�' �'
?��: � �� ;.t�
TUaI improvements (line 4 fhrough line 6) �7�
Tdal value (line 3 pl,s line � (g�
I hereby certify the aboVe i5 We, corred, and Signature otASSessor Date signed
complele.
Verifying aaion - SgnaNre otlwdiWr Date signed
'�''..F�iF"�'''���"� ��----'.a�'��'`v�'zk��3'�t���'�i"�STANDARU�:DEOUCTION'ALCOVIIANCE�._';'��'.'�.�•F�"a�+"��.'-�h"'-,e.��"'^-".;'.'�.-�S§�''�����..�ss.�`�yr�a�"-�—"_-
20_Pay20_
Lesser of 1!2 Homestead
vauauon w 535.000 ' S
SignaWreofAudtor " Datesignetl
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